Resector balloon system

ABSTRACT

A resector balloon system is disclosed generally comprising a catheter with at least one balloon having an outer wall with a resecting, non-slip surface for resecting unwanted biological material, such as tissues or tumors, and a pump that supplies fluid thereto in pulsed fashion to repeatedly deflate and inflate said balloon. In certain embodiments, the pump includes a processor that controls the pulsed supply of fluid based on an established frequency or change in volume. In some embodiments, the system includes a keyed connector with which the pump identifies the balloon type, and in some cases, the system calculates intra-lumen diameters and densities. In some embodiments, the balloon portion of the catheter includes multiple balloon segments, which in some cases, are inflatable separately from one another.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.12/269,495 filed on Nov. 12, 2008, now U.S. Pat. No. 8,226,601 thedisclosure of which is incorporated by reference herein in its entirety.

FIELD OF THE INVENTION

The present invention relates to systems and methods for the resectionof unwanted biological material, such as tissue growths and tumors, inbodily cavities. More specifically, the invention relates to a ballooncatheter with a resecting surface that is operated in a pulsing fashionto resect the target material with minimal trauma.

BACKGROUND OF THE INVENTION

The removal of unwanted and/or life threatening biological material frominterior portions of bodily cavities, such as organs, vessels, articularjoints and structures, sinuses, and various bodily lumens, is a verycommon procedure in various medical specialties and disciplines, such aspulmonology, cardiology, urology, gynecology, gastro-enterology,neurology, otolaryngology, orthopedics, and general surgery.Accordingly, various instruments and methods have been employed toperform these procedures, which are generally well known in the art.

One of the most important complications in such procedures is bleeding.The bleeding and resulting morbidity of tissue that occurs in many ofthe currently known surgical procedures is the result of abrasive,traumatic, and invasive excising and removal techniques. Many of thesetechniques risk perforation of the vessel or lumen in which theprocedure is being performed, resulting in grave complications for thesurgeon and patient. In addition, many patient maladies are simply notremedied by these procedures because no interventional, minimallyinvasive treatment modality exists, the methods are not efficient, safe,and reproducible, and/or the instruments employed lack the appropriatevisualization, physiological measurement, and/or feedback necessary toensure the safety, efficacy, and reproducibility of the procedure.Accordingly, a new type of treatment is required.

One instrument that is commonly used in various types of medicalprocedures is an inflatable balloon catheter, of which many differenttypes exist, which are utilized to perform various necessary functions.For example, these inflatable balloons are often used to control or stopbleeding, to hold instruments in place, or to prevent or facilitateother flow or movement within the bodily cavity. For example, manyurological catheters are held in place via a balloon that impacts thesidewalls of the urinary tract, many gynecological instruments are heldin place via balloons that impact the sidewalls of the vaginal vault,endovascular balloons are often used to control bleeding, inflatableballoons are sometimes used to control the backflow of radio-opaqueagents injected into the cystic duct to detect the presence of gallstones during general surgical cholecystectomy procedures, and,recently, balloon catheters have been employed to release sinuscongestion.

One particular application of such catheters is lung cancer. Among alltypes of cancer, this has the lowest survival rate, as more than onethird of all deaths due to cancer are caused by lung cancer. Over 1.5million new cases are diagnosed worldwide each year. The most frequentcause of death for lung cancer patients is airway obstruction. In lungcancer patients, one third of all cases initially, and another third ofthe cases in the long term, present main airway obstruction, which maycause asphyxia, hemorrhaging, and infection. These complications are themost frequent causes of death in lung cancer patients.

Use of interventional bronchoscopy for the treatment of lung cancer andthe resultant airway obstruction increases the quality of life andsurvival rates of patients suffering from Chronic Obstructive PulmonaryDisease (COPD) and the obstructive co-morbidities associated with thecancer. Accordingly, balloon catheters have been routinely used withvarious endoscopes and with flexible and rigid bronchoscopes fordilation, as a tamponade to stop bleeding, and as an interferencefixation device to hold instruments in place and prevent theretropulsion of those instruments under backflow pressure.

In light of the aforementioned need for a new type of treatment forremoving undesirable biological material in bodily cavities, it has beenrealized that inflatable balloon catheters may further be employed asinterventional tools for the excision and removal of such materials—suchas endoluminal obstructions and tumors and endovascular occlusions—invarious applications, such as the aforementioned interventional medicalspecialties of pulmonology, cardiology, urology, gynecology,gastroenterology, neurology, otolaryngology, and general surgery. Theuse of balloon catheters in this way has presented a method of treatmentthat is simple, safe, highly effective, and inexpensive compared toother types of methods and devices that are used, such as mechanical,laser, electrocautery, cryotherapy, etc.

Accordingly, a new class of balloons has been suggested for thispurpose, such as that disclosed in European Patent Application No. EP 1913 882 by Karakoca. This device employs a balloon catheter with ahardening surface, which can be inserted into bodily cavities. After thedevice is inserted, the balloon is inflated, and the balloon is movedback and forth within the cavity such that the textured surface performsa shaving action on the unwanted biological material. In this way, thetargeted material is resected.

However, this particular instrument and method of using it suffers froma number of disadvantages and shortcomings. One of the most significantproblems with this resector balloon is that unwanted biological materialis removed by shaving it with the hardened surface on the outside of theballoon—i.e., by moving the balloon back and forth and/or rotating it.This mechanism of action can be abrasive and traumatic. Moreover, thehardened surface coupled with the shaving action can sometimes lack theprecision necessary to prevent complications such as bleeding andstructural perforation of the affected anatomical structure.Furthermore, the amount of torque and back and forth force needed on theballoon may cause a device failure, particularly where the balloon isattached to the catheter.

Another disadvantage of this resector balloon is that its hardenedsurface is a separate membrane located on the outside of the balloon.This membrane has different stretching characteristics than the balloonand effects the performance of the balloon catheter negatively. It maybe required to pre-exercise the balloon catheter outside the body beforeuse. Additionally, it may break off under the frictional stresses of theprocedure and further obstruct or compromise the bodily cavity in whichthe balloon is deployed.

Another problem with this resector balloon is that it further lacksaccuracy because it lacks the capability to precisely gauge the size ofthe environment in which it is being used to provide physiologicalmeasurements and feedback that could aid treatment intervention andefficacy. For example, there is no way for the surgeon to know thediameter of the affected bodily cavity itself, proximal or distal to theobstruction therein. Similarly, there is no way for the surgeon to knowthe intra-lumen diameter where the unwanted tissue growth or tumorresides, and further, no way to accurately adjust for changes in thisdiameter over time as the growth or tumor is resected. Because it has nomechanism for measuring the intra-lumen diameter at different pointswithin the cavity, and particularly, how this changes over time, one isnot able to be properly adjust the amount of pressure supplied to theballoon and thereby prevent complications and expedite treatment.

A related problem with this device is that there is no way for aphysician to measure the intra-articular space between two articularstructures, endplates, or surfaces.

Yet another related problem with this device is that there is no way forthe surgeon to know the density of the bodily cavity proximal or distalto the obstruction, nor can the surgeon know the density of the growthor tumor itself. Because there is no mechanism for measuring the densityof the cavity or the obstruction, one is likewise unable to properlycontrol the pressure in the balloon to aid surgical precision, minimizepotential complications, and expedite the procedure.

Still another related problem with this device is that it does not havea way of identifying the type of balloon catheter that is connected tothe pump. As a result, the balloon may be accidentally over-inflated,and thus, the balloon could burst.

Another disadvantage of this resector balloon is that it is comprised ofa single, unitary structure, which means that one is only able toinflate the entire balloon as a whole. This results in severaldeficiencies, including: the inability to measure the intra-lumendiameter at different locations, including both the bodily cavity itself(proximal/distal to obstruction) and the obstructive biologicalmaterial; the inability to pinpoint the location(s) requiring themaximum pressure in order to precisely and methodically resect theobstruction; the inability to tamponade specific areas in order tocontrol bleeding; the inability to capture material that has beenexcised in order to extract it from the bodily cavity; and a tendencyfor the balloon to slip and migrate.

Yet another deficiency of this device is that it is not able to bepositioned as optimally as may be desired. For example, the overalldiameter of this balloon catheter requires a rigid or flexible endoscopewith a working channel. In addition to the fact that such endoscopes maynot be readily available, they are single lumen devices. As a result, aguide wire cannot be used to guide them into bodily cavities eitherthrough a rigid or flexible endoscope or alongside, in parallel to, arigid or flexible endoscope. Likewise, this device does not have theability to linearly translate the balloon along the catheter construct,which would enable one to optimize balloon placement and productivity.Finally, the device does not include material for externally identifyingits position, such as a radio-opaque material. Therefore, one is notable to easily identify the position of the balloon via an externalimaging modality, such as radiographic or ultrasonic imaging. Each ofthese shortcomings contributes to one's inability to position theballoon as precisely as may be desired.

Another disadvantage of this resector balloon is that there is no way toprovide the physician illuminated light, non-thermal illuminated light,and direct visual feedback of the area ahead of the balloon, ahead ofthe balloon looking back towards the balloon, along the sides of theballoon or behind the balloon to optimize treatment intervention andefficacy.

A further deficiency of this resector balloon stems from the fact thatit is a single lumen device where the proximal end is closed off. As aresult, it does not allow for passage of fluid, such as air or blood,from the distal end of the catheter to the proximal end when the balloonis inflated. This is particularly important in interventionalpulmonology applications, where aspiration in the event of airwayobstruction is critical. Likewise, this is important in interventionalcardiology applications to permit the bypass of blood flow during theoperation of a vessel segment.

Another deficiency of this device is that it does not have the abilityto deliver cryogenic agents or forms of energy that could assist in theresection of the undesirable biological material. As a result, one isunable to supply cryogenic agents or forms of energy such asradio-frequency, ultrasonic, and electrosurgical energy in order toperform ablation, desiccation, cauterization, excision, decortications,and/or tissue modification in order to optimize hemostasis andresection.

A further deficiency of these balloon catheters is that there is no wayto provide localized delivery of drugs, stents, biologic materials,nano-particulates, or related technologies to the surface of theballoon. Thus, one is unable to use the device to supply these means ofproviding medicinal, therapeutic, and restorative treatments.

What is desired, therefore, is a resector balloon system for removingundesirable biological materials that does not cause unnecessary traumato the affected bodily cavity as a result of a shaving action used toresect that material. What is also desired is a resector balloon systemwith controllable rates of inflation and deflation. What is furtherdesired is a resector balloon system that does not require a separatemembrane affixed to the exterior of the balloon. What is also desired isa resector balloon system that can be administered either through anendoscope, alongside an endoscope, or via radiographic or ultrasonicimaging. What is also desired is a resector balloon system that is ableto provide physiologic feedback to determine intra-lumen diameters anddensities where the unwanted biological material resides and atlocations proximal or distal to such material, the intra-articular spacebetween two articular structures, and the type of balloon catheterconnected. What is also desired is a resector balloon system that isable to provide dimensional and performance metrics of the ballooncatheter construct in vivo. What is further desired is a resectorballoon system that can be optimally positioned within the bodily cavityand can pinpoint specific areas at which to provide maximum inflation.What is also desired is a resector balloon system that can supply lightand visualization capabilities, cryogenic agents and various forms ofenergy to assist surgical techniques, and drugs and related materials tothe anatomical site. What is further desired is a resector balloonsystem that allows for the passage of fluids from the proximal to thedistal end of the catheter.

SUMMARY OF THE INVENTION

Accordingly, it is an object of the present invention to provide aresector balloon system for removing undesirable biological materialthat does not require a shaving mechanism of action.

It is a further object of the present invention to provide a resectorballoon system for removing undesirable biological material that doesnot employ a separate membrane affixed to the outside of the balloon.

It is yet another object of the present invention to provide a resectorballoon system for removing undesirable biological material thatprovides physiological feedback from which the intra-lumen diameterwhere the material resides, as well as the bodily cavity itself proximaland distal to the material, can be determined, and the pressure and flowsupplied to the balloon can be adjusted accordingly.

It is still another object of the present invention to provide aresector balloon system for removing undesirable biological materialthat provides physiological feedback from which the intra-articularspace between two articular structures, endplates, or surfaces can bedetermined, and the pressure and flow supplied to the balloon can beadjusted accordingly.

It is yet another object of the present invention to provide a resectorballoon system for removing undesirable biological material thatprovides physiological feedback from which the intra-lumen density wherethe material resides, as well as the bodily cavity itself proximal anddistal to the material, can be determined, and the pressure and flowsupplied to the balloon can be adjusted accordingly.

It is another object of the present invention to provide a resectorballoon system for removing undesirable biological material that canidentify the type of balloon catheter that is connected to the pump.

It is still another object of the present invention to provide aresector balloon system for removing undesirable biological materialwhere the balloon portion has different segments that can be inflatedindependently.

It is yet another object of the present invention to provide a resectorballoon system for removing undesirable biological material that has atleast one additional passageway other than that used for the fluid thatinflates the balloon.

It is another object of the present invention to provide a resectorballoon system for removing undesirable biological material that enablesthe balloon to be translated along the catheter.

It is still another object of the present invention to provide aresector balloon system for removing undesirable biological materialthat facilitates exterior imaging.

It is yet another object of the present invention to provide a resectorballoon system for removing undesirable biological material thatprovides visualization from within the bodily cavity.

It is another object of the present invention to provide a resectorballoon system for removing undesirable biological material that candeliver energy to the target area.

It is yet another object of the present invention to provide a resectorballoon system for removing undesirable biological material that candeliver cryogenic agents to the target area.

It is still another object of the present invention to provide aresector balloon system for removing undesirable biological materialthat can deliver drugs, stents, nano-particulates, and similar materialsto the target area.

In order to overcome the deficiencies of the prior art and to achieve atleast some of the objects and advantages listed, the invention comprisesa method of resecting biological material with a resector balloonsystem, the method including inserting a catheter comprising at leastone balloon having an outer wall with a resecting surface into a bodilycavity having biological material to be resected, inflating the balloonby supplying fluid thereto such that the resecting surface of theballoon contacts the biological material, and repeatedly deflating andinflating the balloon by supplying fluid to the balloon in pulsedfashion such that the repeated deflation and inflation causes theresecting surface to resect the biological material.

In some of these embodiments, the step of inflating the balloon includessupplying fluid to the balloon with an electro-pneumatic pump, and thestep of repeatedly deflating and inflating the balloon is controlled bythe electro-pneumatic pump based at least partially on an establishedvolume change or frequency. In some cases, the method further includesdetecting a balloon type for the catheter inserted into the bodilycavity, wherein the step of inflating the balloon is controlled based atleast partially on the balloon type detected, and in certain cases, thestep of repeatedly deflating and inflating the balloon includesdetermining a density of the biological material or a diameter withinthe biological cavity, and adjusting the amount of fluid supplied to theballoon based at least in part on the determined density or diameter.

In some embodiments, the at least one balloon includes a plurality ofballoon segments, and the step of inflating the balloon includesinflating at least one of the balloon segments separately from at leastone other balloon segment.

The invention also comprises a resector balloon system, including acatheter with at least one balloon having an outer wall, the outer wallcomprising a resecting surface for resecting biological material, and apump that inflates the balloon by supplying fluid thereto, wherein thepump supplies fluid to the at least one balloon in pulsed fashion torepeatedly deflate and inflate the balloon.

In some embodiments, In certain advantageous embodiments, the pump is anelectro-pneumatic pump. In some embodiments, the pump includes aprocessor that controls the pulsed supply of fluid based on anestablished frequency, while in other embodiments, the pump includes aprocessor that controls the pulsed supply of fluid based on anestablished change of volume within the balloon.

In some embodiments, the invention further includes a connector thatconnects the catheter to the pump, wherein the connector is a balloonidentification connector with which the pump identifies the balloon. Insome of these embodiments, the connector includes a balloonidentification plate and a key that orients the identification platewhen the catheter is connected to the pump such that the pump identifiesthe balloon using the identification plate. In some cases, the pumpidentifies the balloon from the identification plate electro-optically,while in other cases, the pump identifies the balloon from theidentification plate electro-mechanically. In certain embodiments, thepump includes balloon profile data corresponding to the balloon and aprocessor that controls the supply of fluid to the balloon based atleast partially on the balloon profile data. The balloon profile datamay also include correction data for different types of tissues.

In some embodiments, the pump includes at least one sensor for making atleast one measurement, and a processor that calculates a density of thebiological material in the biological cavity based at least partially onthe at least one measurement and the balloon profile data. In some ofthese embodiments, the at least one sensor includes a sensor thatdetermines the pressure of the fluid output to the balloon and a sensorthat determines the flow of the fluid output to the balloon, and in somecases, the pump controls the supply of fluid to the balloon at leastpartially based on the calculated density.

Similarly, in some embodiments, the pump includes at least one sensorfor making at least one measurement, and a processor that calculates adiameter in the biological cavity based at least partially on the atleast one measurement and the balloon profile data. In some of theseembodiments, the at least one sensor includes a sensor that determinesthe pressure of the fluid output to the balloon and a sensor thatdetermines the flow of the fluid output to the balloon, and in somecases, the pump controls the supply of fluid to the balloon at leastpartially based on the calculated diameter.

In certain embodiments, the system further includes a connector thatconnects the catheter to the pump, wherein the connector is a balloonidentification connector with which the pump identifies the balloon, thepump includes balloon profile data corresponding to the balloon the pumpincludes a processor that determines a desired frequency or change involume in the balloon based at least partially on the balloon profiledata, and the pump controls the supply of fluid to the balloon based atleast partially on the determined frequency of change in volume.

In some embodiments, the at least one balloon comprises a plurality ofballoon segments and the catheter includes a plurality of lumens throughwhich the pump supplies fluid to the balloon segments such that the pumpinflates at least one of the balloon segments separately from at leastone other of the balloon segments.

In certain advantageous embodiments, the system further includes atleast one outer lumen for supplying fluid to the at least one balloonsegment and an inner lumen. In some of these embodiments, the innerlumen comprises an air or bodily fluid passage, while in someembodiments, at least one guide wire is disposed in the inner lumen. Incertain of these embodiments, the system further includes at least onechannel connecting the inner lumen and the outer surface of the balloonfor delivering a medicinal or therapeutic agent to the biologicalcavity. In some of these embodiments, the catheter includes an imagingdevice aperture, further comprising a fiber optic bundle disposed in thecatheter and exiting the hole for viewing the biological cavity. Some ofthe lumens can be used for multiple purposes. For example, once thecatheter is inserted into position with the aid of the guide wire, theinner lumen can then be used for visualization.

In certain embodiments, the pump includes a vacuum source with which thepump evacuates resected material from the bodily cavity, through achannel in the inner lumen. In some embodiments, the pump includes avacuum source that evacuates the fluid from the balloon.

In some embodiments, the system further includes an energy source forsupplying energy and at least one wire molded into the catheter forconducting energy from the energy source to the biological cavity.

In certain advantageous embodiments, the fluid is a gas. In someembodiments, the fluid is a cryogenic fluid.

In certain advantageous embodiments, the system includes a mesh moldedinto the catheter, wherein the resecting surface comprises a texturedsurface of the outer wall of the balloon produced by the mesh. In otherembodiments, the outer wall of the balloon comprises a plurality ofinflatable cavities that provide the resecting surface. In still otherembodiments, the system further includes a plurality of spring wiresmounted to the outer wall of the balloon, wherein the resecting surfacecomprises the spring wires, and in some cases, the system also includesan energy source connected to the spring wires for supplying energythereto.

In some embodiments, the balloon has first and second ends, and thesystem further includes at least one imaging marker mounted adjacent atleast one of the ends of the balloon, which in some cases, comprises aradio-opaque ring.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a front, partially schematic view of a resector balloon systemin accordance with the invention.

FIG. 2A is a front, partially schematic view of the balloon catheter ofthe system of FIG. 1.

FIG. 2B is an end, partially cross-sectional view of the inflatedballoon of the system of FIG. 2A.

FIG. 2C is a partially cross-sectional view of the deflated balloon ofthe system of FIG. 2A.

FIG. 3A is a front, partially schematic view of the balloon catheter ofFIG. 2A employing multiple balloon segments.

FIG. 3B is a side view of the balloon of the catheter of FIG. 3A withthe center balloon inflated.

FIG. 3C is a side view of the balloon of the catheter of FIG. 3A withthe center balloon deflated.

FIG. 3D is a partially cross-sectional view of the balloon catheter ofFIG. 3A.

FIG. 3E is a side view of the balloon of the catheter of FIG. 3A withthe balloon segments spatially separated.

FIG. 3F is a partially cross-sectional view of the balloon catheter ofFIG. 3E.

FIG. 4A is a side, partially schematic view of the balloon catheter ofFIG. 1 with an energy delivery assembly.

FIG. 4B is a side, partially schematic view of the balloon catheter ofFIG. 4A.

FIG. 5 is a side view of the balloon catheter of FIG. 1 with springwires mounted to the balloon.

FIG. 6A is a side, partially schematic view of the balloon catheter ofFIG. 1 with an imaging device.

FIG. 6B is an end view of the imaging device of FIG. 6A.

FIGS. 7A-F are side, partially cross-sectional views of the ballooncatheter of FIG. 1 being operated in a bodily cavity.

FIG. 8 is a block diagram illustrating the pneumatics of the pump ofFIG. 1.

FIG. 9 is a block diagram illustrating the electronics of the pump ofFIG. 1.

FIG. 10A illustrates a front panel of the pump of FIG. 1.

FIG. 10B illustrates a graphical display of the front panel of FIG. 10A.

FIG. 10C illustrates a front panel of a remote for the pump of FIG. 10A.

FIG. 11A illustrates a front panel of the pump of FIG. 1.

FIG. 11B illustrates a rear panel of the pump of FIG. 11A.

FIG. 11C illustrates a front panel of a remote for the pump of FIG. 11A.

FIG. 12A-B is a flow diagram illustrating the operation of the resectorballoon system of FIG. 1.

FIG. 13 is an example of a typical plot of volume versus flow timecharacteristics before and after correction.

DETAILED DESCRIPTION OF THE INVENTION

The basic components of one embodiment of a resector balloon system inaccordance with the invention are illustrated in FIG. 1. As used in thedescription, the terms “top,” “bottom,” “above,” “below,” “over,”“under,” “above,” “beneath,” “on top,” “underneath,” “up,” “down,”“upper,” “lower,” “front,” “rear,” “back,” “forward” and “backward”refer to the objects referenced when in the orientation illustrated inthe drawings, which orientation is not necessary for achieving theobjects of the invention.

The system 20 includes a fluid source (22), such as an electro-pneumaticpump having controls on the front thereof, from which a physician orassistant can control the system (as well as a remote control unit),which is further described below. A balloon catheter (24) is connectedto the pump (22), to which the pump (22) supplies a fluid, such as agas, liquid, or mixture thereof. In certain cases, a cryogenic fluid issupplied by the pump (22) in order to further aid a particularprocedure, such as tumor desiccation.

As shown in FIGS. 2A-B, the balloon catheter (24) includes a catheter(26) made of a polyethylene material and having an outer diameter of 1.8mm and a length of about 1.2 to 3 meters. A bendable section (28) havinga length of about 5 to 10 mm at the distal end of the catheter (24)serves as a safety tip. As a result, when the catheter (24) is insertedthrough the available opening of a bodily cavity, it will bend insteadof puncturing the walls of the cavity.

A balloon portion (30) made of latex or other suitable material islocated near the distal end of the catheter (24) or at an otherwisedesirable, predefined distance along the catheter (24). The balloon (30)comes in a variety of sizes and diameters, which can be selected to suitthe particular application for which the device is being used.Typically, such balloons will have lengths of 5, 10, 15, 20, 30 or 50 mmand diameters of 2.5, 5, 10, 15, 20, 30 or 50 mm. This variety ofavailable balloon sizes allows the balloon catheter (24) to be used inbodily cavities of various diameters and dimensions, such as large andsmall bronchial branches, sinuses, and vessels, having different typesof tumors and tissues to be treated. The pump (22) supplies the air at apressure of approximately 2 atmospheres in order to be able to inflatesuch balloons to full size, ranging from 2.5 mml to 50 mml.

In certain advantageous embodiments, the balloon (30) includes imagingmarkers (32), such as radio opaque rings, located at or near the endsthereof. Such markers can be selected and appropriately positioned inorder to reflect the relevant waves of various imaging modalities (e.g.,x-ray) in order to allow the use of such modalities to assist with theprecise positioning of the balloon (30).

Referring to FIG. 2B, which shows a cross-section of the balloon (30),the balloon is covered with a flexible resecting surface (34), whichmay, for example, comprise a fiber mesh affixed to the surface of theballoon (30). In certain advantageous embodiments, the resecting surface(34) comprises a textured surface approximately 0.2 mm thick that is anintegral part of the balloon and which is incorporated therein duringthe molding process. In these cases, the resecting surface (34) is madeby integrating into the balloon material a fine, fiber mesh, which canbe made of lycra, polyurethane, composite springs, or other appropriatematerial. The crossover point of the mesh members produceoutwardly-facing, small knots or dimples, which create micro-impacts onthe tumor tissue (or other biological material to be resected) duringthe inflation/deflation cycles further described below. In otherembodiments, dimensional surface structures or inflatable sinuses thatare encapsulated in the surface substrate of the balloon (30) areemployed. Such impregnated structures within the surface substrate ofthe balloon can mimic mesh-like structures, bumps, ridges, etc.

Referring back to FIG. 2A, the balloon catheter (24) includes an innerlumen breakout Y junction (40) to facilitate the introduction of a guidewire, air bypass, drug delivery, or visualization conduit. The proximalend of the inner lumen (42) after Y junction (40) is terminated with aluer connector (44). The outer lumens are terminated at their proximalend with a keyed connector (46), which includes a key (48) and a balloonidentification plate (50).

The Y junction (40) serves several purposes. First, it brings out aseparate, inner lumen (42) of the catheter (24) to a suitable connector,such as the aforementioned luer connector (44), in order to provide anindependent passage, such as a two-way air passage between the distaland proximal ends of the balloon catheter (24), which can be critical incertain applications (i.e., bronchoscopy) when the balloon is inflated.Additionally, the Y junction (40) also includes a shut-off valve (notshown) for stopping the balloon (30) from deflating. This may be used,for example, when it is required to leave the inflated balloon in placefor a lengthy period of time in order to treat chronic bleeding.

As noted above, the catheter (24) is terminated at the proximal end witha keyed balloon identification plate (50). The purpose of this connectoris to electronically detect the catheter (24) when it is inserted intothe pump (22) and to identify the particular type of balloon catheterbeing used. The key (48) orients the connector (46) and theidentification plate (50) in such a way that the balloon type can beidentified by the pump (22) using electro-optical or electro-mechanicalmeans.

Each type of balloon (30) that can be used with the pump (22) ischaracterized, and balloon profile data is registered in lookup tables.By identifying the type of balloon (30) that is connected the pump (22),the appropriate profile data can be retrieved and used to ensure thatthe appropriate pressure, volume, flow, and timing adjustments can bemade to safely and effectively operate the balloon (30). The balloonprofile data contained in the lookup table, along with appropriatepressure and flow measurements (as further discussed below), allows oneto make tissue density approximations. This balloon profile data andapproximated lumen diameter and tissue density, as well as any usercommands, are used to adjust the amount of gas the pump (22) delivers tothe balloon (30) in order to achieve the desired inflation and deflationamounts.

As shown in FIG. 2C, which shows a cross-section of the catheter (26) atthe distal end where the deflated balloon (30) with the resectingsurface (34) is located. In certain embodiments, the inner lumen (42) ofthe catheter (26) extends through the bendable section of the cathetertip (28) and is open at the distal end. As noted above, in certainapplications, such as bronchoscopy, this inner lumen (42) serves as apassageway that allows the air to move freely in both directions fromeach end of the balloon (30) when it is inflated. Additionally, theinner lumen (42) can be used as a means for accurately positioning theballoon catheter (24), as it can be used as a conduit for a guide wire(63) when inserting the deflated balloon catheter (24) into the bodilycavity. In other applications, such as in treating coronary arterydisease, bypass holes (not shown) to the inner lumen may be provided atan appropriate location after the proximal end of the balloon (30) andthe inner lumen (42) is thereafter blocked such that a breakout junctiontherefor is unnecessary.

The outer lumens (60) of the catheter (26) are used to inflate anddeflate the balloon (30) through the holes (62) provided in thecatheter's outer walls (64). These outer lumens (60) are blocked at thedistal end of the balloon (30) so that air intended for inflation anddeflation will not escape.

In certain advantageous embodiments, as illustrated in FIGS. 3A-B, theballoon catheter (24) includes a multi-balloon construct (70) at itsdistal end. This construct may include, for example, a proximal balloonsegment (72), a center balloon segment (74), and a distal balloonsegment (76). At the proximal end of the catheter (24), the Y junction(40) brings out another lumen (78) that supplies fluid to the proximalballoon segment (72) and the distal balloon segment (76) separately fromthe center balloon segment (74). The additional lumen (78) is connectedto another keyed connector (80), similar to the keyed connected (46). Inthis way, the center balloon segment (74) is inflated and deflatedindependently of the proximal and distal balloons (72,76).

Employing separate proximal and distal balloon segments in this wayserves several purposes. First, one is able to inflate the proximal anddistal balloon segments (72,76) to an amount appropriate to hold thecatheter (24) steady where the tissue to be removed is located while thecenter balloon (74) is cyclically inflated and deflated to resect theunwanted biological material, as illustrated in FIGS. 3B-C. By doing so,one can prevent the balloon (30) from slipping and migrating during theprocedure, and possibly causing damage to the bodily cavity itself,which is particularly important in cavities subject to significantbackflow pressures and in applications where balloon catheterization isrequired for an extended period of time. Additionally, by inflating theproximal and distal balloons (72,76), one can prevent the resectedmaterial from escaping into the bodily cavity, and instead, can capturethe loose tissue for easy removal. Finally, by employing multiple,independently inflatable bladders or sinuses in this way, one is able tomore selectively and precisely tamponade different sections of thebodily cavity, measure their intra-lumen diameters and densities, andresect obstructive tissue.

FIG. 3D shows how the outer lumens are used to inflate and deflate thethree balloons (72, 74, 76). As noted above, the inner lumen (42) isused for air bypass and/or a guide wire conduit. The lower lumen (82)has inflation/deflation hole (84) in the catheter walls only at theposition along the length of the catheter (24) where the center balloon(74) is located, while the upper lumen (86) contains inflation/deflationholes (88) only at the position along the length of the catheter wherethe proximal and distal balloons (72,76) are located. It should be notedthat the proximal and distal balloon segments (72,76) can also beinflated/deflated independently from each other by further separatingthe outer lumen to include an additional lumen, and positioning theinflation/deflation holes at the appropriate locations along the lengthof catheter (24). Likewise, additional balloon segments could be added,which could each similarly be inflated independently from the others byincreasing the number of lumens and adding a separate termination at theproximal end at the Y junction (40).

Though the balloon segments illustrated in FIGS. 3A-C are shown adjacentone another, in other embodiments, as shown in FIG. 3E, the differentballoon segments may be spatially separated from each other. The balloonsegments may be separated by, for example, a distance of about 1 cm,though this separation can be more or less depending on the particularapplication. By separating the balloon segments in this way, holes (90)can be provided to other lumens (92) in the catheter.

As shown in FIG. 3F, the lumens (92) and holes (90) can be used todeliver, for example, a medicinal drug. In this way, with the proximaland distal balloons (72, 76) remaining inflated and the center balloonresecting the unwanted biological material (as further described below),the drug is contained in the targeted site and evenly distributed. Itshould be noted that, however, that in other embodiments, such drugs,nano-particulates, etc. may be dispersed through multiple distal tips orthrough orifices in the lateral walls of the balloon. Accordingly, suchdrugs can be released via a methodic and/or timed release.

The lumens (92) and holes (90) can be used to deliver any number ofthings to assist with opening the cavity, circulation, aspiration,respiration, assisting the decomposition of an obstruction, orstimulating healing in the affected area, including air, aspirates,drugs, biologics, biogenetic agents, nano-particulates, solutions, stemcell and gene therapies, and stents and scaffolds. Specifically, thedevice could be used for the deployment and implantation ofpro-generative vehicles and/or catalysts in the repair, treatment, andtherapy of the targeted areas, including biologic, nano-particulatematerials and/or biogenetic materials, structures, scaffolds, andsimilar devices and vehicles, including, for example, bone morphogeneticproteins, microcrystalline nano-particulates, collagens, de-mineralizedbone chips, calcium based structures, poly glycolic acids, poly lacticacids, and hyaluronic acids. The device can likewise be used for thedeployment and implantation of inert, inelastic, and semi-rigidmaterials, such as, for example, PEEK, ceramic, cobalt chrome, titanium,and stainless steel, and for the implantation of reinforcing constructswithin, along, and/or around anatomic structures, which may be deployedand then impregnated, impacted, and otherwise filled, either prior to orafter insertion, with inert materials including, for example, polymethylmeth-acrylate, bone cements, polyethylene, polypropylene, latex, andPEEK.

Additionally, in some of these multiple-balloon embodiments, theabove-described imaging markers (e.g., radio opaque rings), can belocated at or near the ends of each balloon segment in order tofacilitate the use of certain imaging modalities to assist with theprecise positioning of the balloons.

As illustrated in FIG. 4A, in certain advantageous embodiments, aflexible catheter (100) with electrically conductive wires (103) andelectrodes (104) is used to deliver energy to a desired biologicalmaterial to be treated. As shown in FIG. 4B, an access hole (106) isused to introduce the electrocautery electrodes (104) to the targetsite. The electrodes (104) are molded into the flexible catheter (100),and are electrically connected to conductive wires (103), which are alsomolded into the catheter (100) and electrically insulated from oneanother. The distal ends of the wires (103) are, in turn, connected toan energy generating device for supplying the requisite energy (108),such as, for example, a suitable electro-surgical unit.

The electrodes (104) are made of suitable spring metals that arestraight inside the lumen of the catheter (26), but spring into theiroriginal shape when pushed out through the access hole (106). Theelectrodes are deployed by pushing the catheter (100) in and out at theY junction (40). The electrodes (104) are positioned in the desiredposition by rotating the balloon catheter (26) and incrementallyinflating and deflating the balloon (30) as needed. It should be notedthat both monopolar (one of the electrodes is remotely connected) andbipolar (both electrodes are localized) implementations may be employed.In this way, various forms and types of energy, such as radio-frequencyand electrosurgical energy, can be supplied in a 360° fashion to performablation, cauterization, excision, decortications, and/or tissuemodification in order to optimize hemostasis and resection. A similarenergy delivery system can be constructed for delivery of ultrasound.

In certain advantageous embodiments, the invention also includesinsulating materials and insulation barriers along and within thesurfaces of the balloon construct to insulate the balloon from thethermal, ultrasonic, and associated deleterious effects of the differentforms energy delivered by the above described balloon catheter (24).Accordingly, the balloon (30) is protected against becoming deflated orotherwise comprised under the stress of the energy delivery process(es).

As illustrated in FIG. 5, in certain embodiments, straight, steel springwires (110) are mounted on the balloon (30) in a cylindrical fashion.The wire ends are fixed to the balloon catheter (24) at the proximal end(112) of the balloon (30) such that they do not move with respect to thecatheter (26). At the distal end (114), the wires (110) are not fixedand extend far into channels that are provided in the balloon catheter(26). Accordingly, when the balloon (30) is inflated, the spring wires(110) are forced by the inflation to take the shape of the balloon (30).In this way, another means of providing a resecting surface for theballoon (30) is provided by insulating the tips of the spring wires(110) from one another and by providing conductive wire (103) outthrough the Y junction (40), which can also be used as to providemonopolar or bipolar electrodes for electrocautery.

In some embodiments, as shown in FIG. 6A, a fiber optic image bundle(120) is introduced through an access hole (122) or (124) to image thesurrounding area. At the proximal end of the balloon catheter (26) the Yjunction (40) provides access through ports (126) and/or (128). Asillustrated in FIG. 6B, the fiber optic image bundle (120) is made of anincoherent fiber bundle (130) for illumination and a coherent imagingfiber bundle (132) at the core, and a lens (not shown). Two separatebundles, one for illumination and the other for image (not shown) canalso be used. At the distal end of the fiber optic bundle (120), theimaging coherent fibers are separated from illumination fibers (notshown) and interfaced to an image sensor, such as CMOS or CCD, throughappropriate optics (not shown). Similarly, the illumination fibers areinterfaced to a light source (not shown). It should be noted, however,that other sources of illumination, such as light emitting diodes, mayalso be employed. It should also be noted that the image sensor (CCD orCMOS available today in 2 mm size) can be located at the tip of theimaging catheter assembly (not shown), eliminating the need for coherentimaging fiber bundle, thus increasing the image quality and reducingcost.

In this sort of way, the physician can be provided with illuminatedlight, non-thermal illuminated light, and direct visual feedback of thearea ahead of the balloon (30), along the sides of the balloon, and/orbehind the balloon. The imaging sensor and illumination optics possessthe ability to be translated linearly or rotationally through and/oraround the balloon (30), thereby allowing for 360° visualization of thetreatment area.

The operation of the balloon (30) can be generally described withreference to FIGS. 7A-F. Referring first to FIG. 7A, after a visualinspection via an endoscope, x-ray, and/or ultrasound, a ballooncatheter is selected, and the deflated device is inserted into positionin a bodily cavity. This may be accomplished by using the workingchannel of an endoscope or, as previously noted, along a guide wire thatis previously inserted into the body and inserting the proximal end ofthe guide wire which is outside the body into the inner lumen of thecatheter. The catheter is connected to a pump (the components andoperation of which are further described in detail below), at which timethe pump determines the type of balloon catheter that has been inserted.

Referring next to FIG. 7B, the balloon is inflated by the pump (whichknows the type of balloon to which it is connected) at an air pressureof approximately 2 atmospheres for a fixed amount of time, and the flowis measured (after the physician presses an inflate button on the pump).The pump than calculates the initial approximation of the tissue densityand the size of the opening in the tumor tissue, and displays theresults for confirmation by the physician. As the pump is operated, thisdata is continuously updated and displayed.

As shown in FIGS. 7C-D, when a pulse button on the pump is pressed, theballoon is deflated and inflated in a cyclical fashion, based either onparameters that were entered by the user, or on default parametersselected by the pump, which are based on the characteristics of theparticular balloon (which has been identified as a result of theaforementioned balloon identification plate) and the diameter and/ordensity measurements made by the system. In this way, the pulse mode ofthe pump causes the balloon to pulsate according to a desired frequencyor change in volume within the balloon, producing a periodicallyrecurring increase and decrease in balloon size.

Accordingly, the resecting surface of the balloon repeatedly comes intocontact with the tissue growth, tumor, or other unwanted obstruction tocreate micro-impacts thereon. As the balloon is deflated and inflated,the resecting surface creates just enough interference fixation,concentrically, along with compressive force excitation and frictionupon the unwanted biological material, to promote compressive forceexhaustion and abrasion to elicit the decomposition and excisionthereof, such that the targeted biological material is resected in anon-traumatic way. As the tissue is destroyed and removed, the balloonis inflated to a larger starting diameter and these steps are repeateduntil all the unwanted tissue is resected.

Meanwhile, the pump continually monitors the balloon pressure and gasflow, and it updates a graphical display accordingly, as is furtherdescribed below. This gives the physician an indication as to when tostop the pulse mode and evacuate the loosened tissue.

Referring to FIG. 7E, once the tumor and/or tissue is broken up, theballoon is deflated (by pressing a deflate button on the pump), and theballoon is inserted further distally into the bodily cavity, past thelocation of unwanted tissue.

A shown in FIG. 7F, the balloon is then re-inflated (by pressing theinflate button on the pump) and gently pulled towards the proximal end,bringing with it the loose tissue and debris to a point where it can beremoved using forceps or suction. In a multi-balloon construct, thedebris can be removed through one of the available lumens.

For example, one particular application to optimize 360° lumendes-obstruction, des-occlusion, cleansing, and debris capture involvesthe use of four bladders in series. All four bladders are first inflatedto des-obstruct the lumen. Then, the distal bladder is inflated fully,while the middle distal bladder is deflated completely and the middleproximal bladder is deflated partially. As the balloon catheter isretracted, the middle proximal bladder is optimally inflated, rotationof the middle proximal bladder is initiated, and the debris is thusresected from the inner walls of the lumen. The debris is then capturedupon retraction upon the fully inflated distal bladder and containedwithin the middle distal and proximal bladders.

These steps are repeated as many times as necessary until all of theunwanted tissue is removed. Typically, the procedure will between 5-45minutes, depending on the density of the tumor or unwanted tissue.

A pump (22) that controls the operation of the resector balloondescribed above will hereafter be described. FIG. 8 represents a blockdiagram of the pneumatic components and operation of the pump. The pumpincludes an air compressor (232) and a pressure tank (233), such as aFesto model CRVZS-0.1, which enable it to achieve up to 10 atmospheresof continuous pressure. The air pressure in the tank (233) iscontinuously monitored by a microcontroller (254), which is furtherdescribed in connection with the electronics of the pump (FIG. 9) below.The microcontroller initiates the compressor (232) to operate via anelectrical signal output (253) when the tank pressure drops below 4-5atmospheres. The size of the tank (233) is selected such that at leastone procedure can be completed without the compressor operating. Themicrocontroller calculates and displays the amount of air in the tank(233), which indicates to the user whether there is enough air tocomplete the procedure. A check valve (234), such as a Festo modelH-1/8-N1, is located between the compressor (232) and the tank (233) inorder to prevent the pressured gas from flowing back into the compressor(232). In another variation of the pump (22), however, theabove-referenced compressor and pressure tank are not included, and thepressurized air or carbon dioxide is instead provided from an externalsource, such as gas tank or the operating room walls commonly found inan operating room.

The pressurized gas from the air tank (233) first goes through apressure regulator (238), which is electronically controlled via ananalog electrical output (0V-10V) signal (246) generated by themicrocontroller to supply air to the balloon at an exact pressure, whichcan be set and changed by the physician. However, any pressures higherthan the upper limit for the particular balloon being used will generatea warning signal. As explained above, different balloon catheters may beused depending on the application, which are identifiable via keyconnectors. Therefore, pressure, volume, and flow characteristics ofdifferent types of balloons are contained in lookup tables in order tooptimize the operation of the balloons and to ensure their consistentperformance.

Accordingly, when the pressure is set higher than the balloon's upperlimit, the detection of gas flow will cause the pump to stop and producethe warning, and the physician must then take a specific action tooverride this condition. Similarly, if there is no balloon pressure, thedetection of gas flow will also generate a warning, as this may mean theballoon has ruptured. It should further be noted that the pump will alsonot operate if a catheter is not connected. Additionally, a balloon'soperation when first removed from the packaging may vary from its normaloperation, requiring that they are first exercised before use in thebody. Therefore, the setup and preparation function of the pump allowsfor this variance.

In certain advantageous embodiments, a vacuum source (239), such as aFesto model VN-05-L-T3-PQ2-VQ2-R01-B, is also included in the pump sothat the balloon can be rapidly deflated in a consistent manner. Thiscomponent also aids in achieving higher frequencies during the pulsemode of operation. The vacuum source (239) is turned on and off by themicrocontroller via an electrical output signal (247).

Two microprocessor-controlled solenoid valves—a deflation valve (240)and an inflation valve (241)—are used to control the inflation anddeflation of the balloon. The appropriate balloon inflation size isachieved by keeping the gas pressure constant, using the balloonpressure, flow, and volume characteristics from the lookup table data,and timing the on/off activation periods of the valves (240, 241).Deflation valve (240) and inflation valve (241) are controlled by adeflate electrical signal (248) and an inflate electrical signal (249),respectively, which are generated by the aforementioned microcontroller.

The gas pressure is continuously monitored by the microcontroller usingpressure regulator (242) at the input from the tank (233), a pressureregulator (243) at the output of the regulator (238), and pressureregulator (244) at the output to the balloon. These pressure regulators,which may be, for example, Festo model SDET-22T-D10-G14-U-M12, provideto the microcontroller analog electrical signal (0V-10V) inputs (250,251, 252) that vary proportionally to the pressure at the regulators(242, 243, 244). The gas passes through an electronic flow meter (245),such as a Festo model SFET-F010-L-WQ6-B-K1, and a filter (246), beforebeing delivered to the balloon. The flow meter (245) provides an analogelectrical signal input (254) to the microcontroller that indicates theamount of gas flow to the balloon.

The pressure regulator (244) and flow meter (245), along with the knowndimensions of the balloon, provide the feedback necessary to determinethe tumor dimensions and resistance via circumferential force and depthresistance, from which a determination is made as to the diameter of thelumen and the density of the tumor. Using these parameters, themicrocontroller makes the appropriate pressure and timing adjustmentsnecessary to maximize the effectiveness of the balloon, provide thephysiologic metrics of the affected and non-affected areas, and providedata points and indicators related to the specific dimensional anddensity characteristics of the intra-lumen anatomy and pathology aid thephysician in safely determining and delivering treatment.

In this way, the gas pressure is strictly monitored and maintained at 2atmospheres in order to keep the balloon from bursting. The high gasinput pressure (up to 10 atmospheres) is reduced to and regulated at 2atmospheres electronically and under software control. However, thepressure delivered to the balloon can be increased or decreased undercertain conditions via operator commands.

In some embodiments, one more temperature sensors are also employed totake continuous physiologic temperature readings of the tissues, tumors,membranes, or other intraluminal tissues and/or devices (whether organicor inorganic) in vivo, before, during, and after the application ofcryogenic and/or thermal treatment modalities. In some embodiments, thesystem takes continuous temperature readings of a cryogenic or thermaltreatment device, in vivo, and concurrently assess the temperatures,rates of temperature changes, and depth of energy penetration into theintraluminal tissues to facilitate control of the distribution and/orapplication of the cryogenic or thermal treatment modality in order tooptimize tissue modification and/or dissection.

FIG. 9 represents a block diagram of the components and operation of theelectronics of the pump (22). The microcontroller (254) is a RISCprocessor and lies at the heart of the electronics. Connected to themicrocontroller (254) through appropriate electrical signals are theusual static, dynamic, and flash memory (255) for firmware and data,lookup table (256), and an interface (257) for communication withexternal devices. This interface can be used for programming, updating,diagnostics, and/or control through a Universal Serial Bus (USB) (258).An interface to a remote control hand held unit (278), further describedbelow, can also be established through the interface circuit (257).Additionally, the pump includes a real time date time integrated circuit(not shown).

A digital-to-analog (D to A) converter (268) is used to control thepressure regulator that supplies air pressure to the balloon. The D to Aconverter (268) generates an analog electrical signal (269) from 0V to10V that is proportional to the desired pressure. A series ofanalog-to-digital (A to D) converters (270) allows the microcontroller(254) to read the pressure signal (250) at the pressure air tank (233),the pressure signal (251) at the output of the pressure regulator (238),the pressure signal (252) at the output to the balloon, and the air flow(254) to the balloon.

Another series of digital outputs with appropriate interface circuits(275) allows the microcontroller (254) to control the compressor (232)(ON/OFF) with command signal (253), the vacuum source (239) (ON/OFF)with command signal (247), the deflate solenoid valve (240) (Open/Close)with command signal (248), and the inflate solenoid valve (241)(Open/Close) with command signal (249).

A series of input circuits (276) are connected to switches on the frontpanel of the pump (22) in order to input user controls, which is furtherdescribed below. Additionally, a display driver circuit (277) interfacesthe microcontroller (254) to the front panel LCD display, also describedbelow.

As shown in FIG. 10A, in certain embodiments, the pump (22) includesuser control buttons in the form of soft keys (263) along the bottom andside of a graphical LCD display panel (264). The functions of thecontrol buttons (263) are displayed on the LCD panel (264) and changedepending on the mode of the pump. The buttons (263) can be used toenter a setup mode, display settings, recall collected data, orincrease/decrease frequency and pressure. In addition to the soft keyfunctions, the graphical LCD display (264) may show the pump's settings,pressure, frequency, and flow values, warnings, other information suchas time, date, and lapse time, and any other information that may beuseful to the physician for conducting the procedure and for gatheringprocedural data, as shown in FIG. 10B.

The front panel of the pump (22) includes a deflate button (259), aninflate button (260), and a pulse button (261) to change the mode inwhich the pump (22) is operating. The front panel also includes anOn/Off switch (265), as well as an emergency stop button (266), whichstops the airflow to the balloon by closing the inflate valve (241) andopening the deflate valve (240) and starting the vacuum source (239).Also included on the front panel of the pump (22) is one or more keyedreceptacle(s) (267) for the aforementioned keyed connector(s) of theballoon catheter.

In certain embodiments, the front panel of the pump (22) also includesan interface (210) for a handheld remote control (278), as previouslydescribed. This handheld remote control (278), shown in FIG. 10C, can belocated in the sterile field, and can be hardwired or wirelesslyconnected to the pump (22) using readily available communicationtechnologies, such as infrared or radio frequency (i.e. Bluetooth). Justlike the front panel of the pump (22), the remote control (278) hasthree push buttons (259, 260, 261) for deflation, inflation, and pulsecommands. The remote control (278) also has a ready light (262) thatindicates when it is ready to accept a command.

As shown in FIG. 11A-C, in another variation of the pump (22), thecompressor, the pressurized air tank, and the vacuum source are notincluded. Even though the balloon could deflate faster with a vacuumsource, the elasticity of the fiber mesh and latex balloon will stillgenerate sufficient frequency to make it useful. As shown in FIG. 11A,the front panel of the device includes a pump On/Off switch (215), aballoon TYPE selector knob (216), a balloon OUTLET connector (217), aballoon inflation/deflation RATE selection push button switch (218), andrate L (low), M (medium), and H (high) indicator LEDs (219). As shown inFIG. 11B, the rear panel includes a VAC power inlet (220), PRESSUREcontrol knob (221), pressurized gas INLET connector (222) and REMOTEcontrol connector (223). The balloon pressure gauge is located on top ofthe unit.

The operation of the system will now be described with reference toFIGS. 12A-B. An initialization step includes setting up and runningdiagnostic testing on all internal components, including pressuretransducers, flow meters, solenoid valves, etc., and displaying anywarnings or, if no problems are detected, displaying a system READYindication to the user (step 300).

After initialization, the pump opens the deflate valve and closes theinflate valve to insure that there is no air pressure and flow at theoutlet to the balloon catheter (step 302). The system will then read theinternal tank pressure (step 304). If the pressure is too low (decisionblock 306), the system will display the amount of air available and waitfor user confirmation to start the compressor (step 308). Alternatively,if an internal compressor is not available, the air pressure at theinlet will be read and a warning will be displayed to connect externalpressured air.

The system will then display a message and wait for a balloon catheterto be connected. When the balloon is connected, it will be detectedthrough electro-optical or electro-mechanical means (step 310) anddisplay a message to the user to confirm the balloon type (step 312). Ifconfirmed with the user (decision block 314), the system will thendisplay a message to the user to confirm that the balloon should betested (step 316) and, if confirmed by the user (decision block 318),the balloon will be tested and pre-exercised (step 320). The system willthen display a message to the user (step 322), and upon receivingconfirmation from the user (decision block 324), will scan for a commandfrom the front panel, the remote control, or a serial interface (step326). During the operation of the system and while waiting for acommand, receipt of the emergency stop command will cause the rapiddeflation of the balloon.

Each “inflate” command (command 330) will inflate the balloon by anincremental amount based on the type of balloon that is connected (step332). This incremental inflation is accomplished by opening the inflatevalve for a set amount of time while the deflate valve remains closed.In this way, the balloon is inflated to the size desired by the user.Alternatively, pressing and holding the inflate button will inflate theballoon in a continuous fashion.

While inflating, the flow of gas (ml/sec) is measured (step 332). Afterclosing the inflate valve, the balloon pressure is measured, and anapproximation of the volume V is made based on the ideal gas law(V=nRT/P) and the lookup table, which contains balloon characteristicsand universal constants (step 334). Here, T is assumed constant at 310°K (body temperature can be measured and entered into the equation aswell), R is a gas law constant, n is moles of gas, which is proportionalto the measured flow, and P is the measured pressure. With eachincremental inflation, V is recalculated, and the relative volume change(V2−V1) is displayed (step 336). Knowing the shape of the balloon fromthe balloon identification, and using the data from the lookup table,the relative change in balloon diameter (D2−D1) is also calculated anddisplayed. As shown in FIG. 13, typical volume versus flow timecharacteristic data can be depicted in a graphical format. A typicalcharacteristic performance curve of the balloon (400) is translated toan actual linear performance (401).

Similarly, each “deflate” command (command 340) incrementally deflatesthe balloon by opening the deflate valve for set period of time whilethe inflate valve remains closed (step 342).

When the pump receives a “pulse” command (command 350), the balloon isinflated and deflated in a pulsed fashion based on set parameters (step352, decision block 354, step 356, decision block 358), which include aninflation priority. In the pulse mode, this aspect of theinflate/deflate cycles can be set as desired. The pump has a feature tocontrol this function based on change in volume (delta volume) orfrequency priority. Because the gas pressure is maintained at a constantvalue (i.e., 2 atmospheres), the time it will take to inflate theballoon to the desired size will vary due to the different sizes andvolumes of the types of balloons. Therefore, in the delta volumepriority, the maximum and minimum frequencies are calculated and set forthe particular balloon used in order to maximize the delta volumebetween the inflated and the deflated states. In the frequency priority,the maximum and minimum delta volumes are calculated and set for theparticular balloon in order to maximize the frequency of theinflate/deflate cycles.

Delta volume and/or frequency is calculated for each inflation/deflationcycle, and the display is updated accordingly. If the “Inflate” buttonis pressed during this pulse mode, the pulse mode is stopped with theballoon in the inflated state. Likewise, if the “Deflate” button ispressed during the pulse mode, the pulse mode stops with the balloon inthe deflated state.

If the user wishes to change the set frequency and/or delta volume forthe pulse mode, this can be done by pressing the Up/Down soft keyslocated on the LCD display panel (command 360, steps 362-364). The usercan also press soft keys located on the display panel to enter thestatus and setup displays (command 370, steps 372-374). These includescreens to set up and enter initialization data into the system, and todisplaying data accumulated during the procedure.

It should be noted that, during all states of operation of the pump, thevacuum source is turned on and off to achieve faster deflation andhigher inflation/deflation cycles.

It should be noted that, while the described embodiments have at timesbeen described with respect to use on tumors and tissue, the system mayalso be employed in other applications. Similarly, while the presentinvention has been described with respect to the pulsation mechanism ofaction described herein, such action is not exclusive. That is, othermechanisms of action may be employed in addition to pulsation as needed,such as linear translation of the balloon along the catheter, as well asrotation. Such motion may be particular useful in cases, such as, forexample, plaque excision and mucosa resection in ENT applications.

Another example in which the above-described system can be usefullyemployed is to remedy the decompression of compressed articulations inrestoring articular joint spaces, heights, and functions in a minimallyinvasive fashion. The decompression balloon includes a wide variety ofshapes and dimensions to address and replicate the broad anatomic jointdimensions found in human and other mammalian bodies, including thespine, knee, shoulder, hip, ankle, elbow, wrist, hands, fingers, feet,toes jaw, ribs, clavicle, and related articulations. An application ofthis art would be as a minimally invasive method to deploy aninterspinous process spacer comprised of a unique geometric, dimensionalballoon construct that possessed the ability, when inflated, todecompress the interspinous process articulation. The balloon constructcould be inserted under endoscopic, radiographic, and/or ultrasoundvisualization via a small incision and/or via wire guidance. Then, theballoon spacer would be inflated to provide the requisite decompressionof the interspinous process. As a result, the stress shielding andfailure modalities often witnessed using current materials and methodscan be mitigated. This method is widely applicable to the many articularjoints in the human and mammalian bodies.

The above-described system can be used for minimally invasiveinterventional treatment for Facet Joint fusion. A unique dimensionallyshaped balloon that mimics the articular surfaces of the facet joint isdeployed to the facet joint via wire guidance under endoscopic and/orfluoroscopic visualization and then inflated. The abrasive mesh-likesurface of the balloon is concentrically and radially pulsed to createmicro-abrasions upon the articular cartilage, and ablative energy isthen applied to the conductive ridges atop the exterior surface of theballoon, eliciting decomposition and decortication of the articularsurface. Any bleeding is tamponaded by inflating the balloon to createcompression and/or via application of electrosurgical energy that istransmitted via the conductive ridges atop the exterior surface of theballoon. The balloon is then rotated to further decorticate and widenthe articular space. The balloon is then deflated, and an inert implant,bone dowel, or other osteo-conductive and osteo-promotive biologicimplant is then inserted along the deflated catheter and/or guide wireand into the articular joint space to create an interference fit andpromote fusion. An iteration of this procedure would also include thedeployment of a facet joint replacement implant. This procedure hasbroad application across the broad spectrum of articular joint fusionand articular joint replacement.

It should be understood that the foregoing is illustrative and notlimiting, and that obvious modifications may be made by those skilled inthe art without departing from the spirit of the invention. Accordingly,reference should be made primarily to the accompanying claims, ratherthan the foregoing specification, to determine the scope of theinvention.

What is claimed is:
 1. A resector balloon system, comprising: a cathetercomprising at least one balloon having an outer wall, said outer wallcomprising a resecting surface for resecting biological material; and apump that inflate/s said balloon by supplying fluid thereto; whereinsaid pump supplies fluid to said at least one balloon in pulsed fashionfor at least a plurality of pulses to produce an established volumechange in the balloon for each of the plurality of pulses, wherein theestablished volume change in the balloon remains constant for at leastthe plurality of pulses, to repeatedly deflate and inflate said balloonsuch that the resecting surface resects the biological material.
 2. Thesystem of claim 1, wherein said pump comprises an electro-pneumaticpump.
 3. The system of claim 1, further comprising a connector thatconnects said catheter to said pump, wherein said connector is a balloonidentification connector with which said pump identifies said balloon.4. The system of claim 3, wherein said connector comprises: a balloonidentification plate; and a key that orients said identification platewhen said catheter is connected to said pump such that said pumpidentifies said balloon using said identification plate.
 5. The systemof claim 4, wherein said pump identifies said balloon from saididentification plate electro-optically.
 6. The system of claim 4,wherein said pump identifies said balloon from said identification plateelectro-mechanically.
 7. The system of claim 3, wherein said pumpincludes: balloon profile data corresponding to said balloon; and aprocessor that controls the supply of fluid to said balloon based atleast partially on said balloon profile data.
 8. The system of claim 7,wherein said pump comprises: at least one sensor for making at least onemeasurement; and a processor that calculates a density of the biologicalmaterial in a biological cavity based at least partially on the at leastone measurement and said balloon profile data.
 9. The system of claim 8,wherein said at least one sensor includes a sensor that determines thepressure of the fluid output to said balloon and a sensor thatdetermines the flow of the fluid output to said balloon.
 10. The systemof claim 8, wherein said pump controls the supply of fluid to saidballoon at least partially based on the calculated density.
 11. Thesystem of claim 7, wherein said pump comprises: at least one sensor formaking at least one measurement; and a processor that calculates adiameter in a biological cavity based at least partially on the at leastone measurement and said balloon profile data.
 12. The system of claim11, wherein said at least one sensor includes a sensor that determinesthe pressure of the fluid output to said balloon and a sensor thatdetermines the flow of the fluid output to said balloon.
 13. The systemof claim 11, wherein said pump controls the supply of fluid to saidballoon at least partially based on the calculated diameter.
 14. Thesystem of claim 1, further comprising a connector that connects saidcatheter to said pump, wherein: said connector is a balloonidentification connector with which said pump identifies said balloon;said pump includes balloon profile data corresponding to the saidballoon; said pump includes a processor that determines a desiredfrequency or change in volume in said balloon based at least partiallyon said balloon profile data; and said pump controls the supply of fluidto said balloon based at least partially on the determined frequency orchange in volume.
 15. The system of claim 1, wherein: said at least oneballoon comprises a plurality of balloon segments; and said catheterincludes a plurality of lumens through which said pump supplies fluid tosaid balloon segments such that said pump inflates at least one of saidballoon segments separately from at least one other of said balloonsegments.
 16. The system of claim 1, further comprising: at least oneouter lumen for supplying fluid to at least one balloon segment; and aninner lumen.
 17. The system of claim 16, wherein said inner lumencomprises a fluid passage.
 18. The system of claim 16, furthercomprising at least one guide wire disposed in said inner lumen.
 19. Thesystem of claim 16, further comprising at least one channel connectingsaid inner lumen and the outer surface of said balloon for delivering amedicinal or therapeutic agent to a biological cavity.
 20. The system ofclaim 16, wherein said catheter includes an imaging device aperture,further comprising an fiber optic bundle disposed in said catheter andexiting said aperture for viewing said biological cavity.
 21. The systemof claim 16, further comprising: an energy source for supplying energy;and at least one wire molded into said catheter for conducting energyfrom said energy source to said biological cavity.
 22. The system ofclaim 16, further comprising at least one channel connecting said innerlumen and the outer surface of said balloon, wherein said pump includesa vacuum source with which said pump evacuates resected material fromsaid bodily cavity, through said channel and said inner lumen.
 23. Thesystem of claim 1, further comprising a mesh molded into said catheter,wherein said resecting surface comprises a textured surface of the outerwall of said balloon produced by said mesh.
 24. The system of claim 1,wherein the outer wall of said balloon comprises a plurality ofinflatable cavities that provide said resecting surface.
 25. The systemof claim 1, further comprising a plurality of spring wires mounted tothe outer wall of said balloon, wherein said resecting surface comprisessaid spring wires.
 26. The system of claim 25, further comprising anenergy source connected to said spring wires for supplying energythereto.
 27. The system of claim 1, wherein said balloon has first andsecond ends, further comprising at least one imaging marker mountedadjacent at least one of the ends of said balloon.
 28. The system ofclaim 27, wherein said at least one imaging marker comprises aradio-opaque ring.
 29. The system of claim 1, wherein said fluid is acryogenic fluid.
 30. The system of claim 1, wherein said fluid is a gas.31. The system of claim 1, wherein said pump further comprises a vacuumsource that evacuates the fluid from said balloon.
 32. The system ofclaim 1, wherein said resecting surface comprises a mesh affixed to theouter wall of said balloon.
 33. The system of claim 1, wherein said pumpincludes an input for selecting the volume change in the balloon. 34.The system of claim 1, wherein said pump includes an input for adjustingthe volume change in the balloon.
 35. A resector balloon system,comprising: a catheter comprising at least one balloon having an outerwall, said outer wall comprising a resecting surface for resectingbiological material; and a pump that inflates said balloon by supplyingfluid thereto; wherein said pump supplies fluid to said at least oneballoon in pulsed fashion for at least a plurality of pulses to producean established volume change in the balloon for each of the plurality ofpulses to repeatedly deflate and inflate said balloon such that theresecting surface resect the biological material; wherein theestablished volume change in the balloon remains constant for theduration that said pump supplies fluid to said at least one balloon inpulsed fashion.
 36. The system of claim 35, wherein said resectingsurface comprises a mesh affixed to the outer wall of said balloon.